Supreme Court to hear ACA challenge by religious nonprofits The U.S. Supreme Court announced last week that it would hear another group of court cases that challenge the Affordable Care Act (ACA) requirement that health plans provide a full range of contraceptive coverage to women at no cost. Under the law, religious institutions, including churches, temples and mosques, are automatically exempt from the ACA's contraceptive coverage requirement and do not have to file any paperwork. Nonprofit faith-based charities and religiously affiliated educational institutions and hospitals, however, must notify the health plan or the U.S. Department of Health and Human ... November 19, 2015 Managed Care Affordable Care Act, Contraception, United States Supreme Court, ACA 0 0 Comment Read More »
Ask the expert: If an exchange patient is in the 90-day grace period and fails to pay the premium, is the plan required to pay for services provided? Maybe. Under the Affordable Care Act, exchange enrollees who receive federal premium subsidies to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. Insurance ID cards for exchange enrollees do not indicate whether the enrollee is subsidized, but Covered California recently reported that 90 percent of California exchange patients are receiving subsidies, so the likelihood of encountering a patient receiving subsidies is very high. In the first month of the grace period, federal law and California regulations require ... November 10, 2015 Managed Care Grace Period, Exchange plans, Health Insurance Exchange 0 0 Comment Read More »
Be prepared for Covered California changes in 2016 In 2015, Covered California, California's health benefit exchange, enrolled approximately 1.3 million individuals in qualified health plans. With Covered California estimating it may enroll an additional 300,000-plus during the 2016 open enrollment period (running November 1, 2015, through January 31, 2016), and two new plans in the mix, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2016. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association ... November 9, 2015 Managed Care Health Insurance Exchange, Surviving Covered California, Covered California 0 0 Comment Read More »
DMHC fines Blue Shield and Anthem for provider directory inaccuracies On November 3, the California Department of Managed Health Care (DMHC) announced it had fined two of the state's largest health plans for inaccurate Covered California provider directories. Blue Shield of California was fined $350,000, while Anthem Blue Cross was fined $250,000. These two insurers account for almost 60 percent of patient enrollment in Covered California. Both insurers are also utilizing networks for their exchange/mirror products that are significantly narrower than their regular PPO networks. These narrowed networks, combined with inaccurate provider directories, have led to significant confusion and frustration ... November 9, 2015 Managed Care Blue Shield, Covered California, Department of Managed Health care, Anthem Blue Cross 0 0 Comment Read More »
State issues new report cards for HMOs, PPOs, and large medical groups The California Office of the Patient Advocate (OPA) recently released its 15th annual “California Health Care Quality Report Cards,” which rates the state's health plans and medical groups on a four-star scale. Available in English, Spanish and Chinese, the report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys from 2013. Users can ... October 31, 2015 General, Managed Care Quality of Care, Commercial Insurance, HMOs, PPOs 0 0 Comment Read More »
New CMS rule changes meaningful use requirements The Centers for Medicare and Medicaid Services (CMS) this week published new rules for the current and final stages of the electronic health record (EHR) incentive program. In publishing the rule, CMS acknowledged the difficulties physicians have experienced with meeting meaningful use requirements. The regulations announced are intended to ease the reporting burden for providers, support interoperability and improve patient outcomes. While the modified rules for years 2015-2017 are final, the stage 3 portion of the final rules were released with the opportunity for public comment, with the expectation that CMS ... October 14, 2015 Managed Care, Medi-Cal, Medicare EHR, Electronic Health Record, Meaningful Use, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
Members of Congress urge HHS to pause meaningful use stage 3 The California Medical Association (CMA) and the American Medical Association (AMA) are urging the U.S. Department of Health and Human Services (HHS) to delay implementing stage 3 of the electronic health record (EHR) meaningful use program, as it is fraught with problems that need to be fixed before the next stage is implemented. CMA and AMA are also pushing for an automatic hardship exemption for physicians who were unable to successfully report in 2015. To that end, at AMA and CMA’s urging, Congress sent a bipartisan letter to HHS ... October 14, 2015 Managed Care, Medicare Electronic Health Record, Regulatory Advocacy, EHR, Meaningful Use 0 0 Comment Read More »
Like it or not, ICD-10 is here - what practices need to know After much debate and years of delay, the October 1, 2015, implementation date for ICD-10 has finally arrived. While concerns remain as to the preparedness of physician practices for this monumental transition, the full impact of the ICD-10 conversion will likely not be felt for several weeks or until the first payment remittances are received. CMA resources As the implementation unfolds, there likely will be unanticipated hurdles that need to be overcome. The California Medical Association (CMA) has a number of resources to help members prepare. CMA ICD-10 ... October 14, 2015 General, Managed Care ICD-10, Practice Resources 0 0 Comment Read More »
ICD-10 Has Arrived! The ICD-10 implementation date has finally arrived. While concerns remain as to the preparedness of physician practices, vendors and payors for this monumental transition, the full impact of the ICD-10 conversion will likely not be felt for several weeks or until the first payment remittances are received. In an effort to help practices navigate the transition, CMA has just published an FAQ titled, “Surviving ICD-10: An FAQ for physician practices." This resource is available free for CMA members (it is not accessible at all for non-members). We will be ... October 1, 2015 Managed Care, Medi-Cal, Medicare ICD-10 0 0 Comment Read More »
California has the most exchange enrollees in the U.S. California has enrolled more people through its Affordable Care Act (ACA) health insurance exchange of any state, with about 1.4 million enrollees as of June 30, according to new federal data. California surpassed Florida – with 1.3 million exchange enrollees as of the end of June – to have the highest exchange enrollment. Nationwide, 9.9 million U.S. residents signed up for the ACA. About 7.2 million consumers purchased coverage through the federal exchange and 2.7 million purchased coverage through state-based exchanges. Of those who purchased coverage in California, 9,302 people who ... September 23, 2015 Managed Care Exchange Plans, Health Insurance Exchange, Affordable Care Act, Covered California 0 0 Comment Read More »
